Peripheral eosinophilia as an indicator of meningitic angiostrongyliasis in exposed individuals

The diagnosis of meningitic angiostrongyliasis (MA) is based on clinical criteria. A lumbar puncture is used as a diagnostic tool, but it is an invasive procedure. The blood eosinophil levels are also assessed and used in the diagnosis of this disease. We enrolled 47 patients with serologically proven MA and 131 controls with intestinal parasite infections. An absolute eosinophil count model was found to be the best marker for MA. An eosinophil count of more than 798 cells led to sensitivity, specificity, positive predictive and negative predictive values of 76.6%, 80.2%, 58.1% and 90.5%, respectively. These data support the use of testing for high blood eosinophil levels as a diagnostic tool for MA in individuals that are at risk for this disease.     

Specificity of immunoblotting analyses in eosinophilic meningitis

Angiostrongylus cantonensis and Gnathostoma spinigerum are the two most common causative parasites of eosinophilic meningitis (EOM). Serological tests are helpful tools for confirming the identity of the pathogen. Recent reports determined the specificity of such tests by using normal healthy controls. There have been limited studies done to rule out the cross-reactivity between these two causative parasites of EOM. This study aims to assess the specificity of the serological test in EOM by using each condition as a control for the other. Thirty-three patients with a diagnosis of EOM were enrolled. Sera from 22 patients with a positive 29-kDa antigenic diagnostic band of A. cantonensis were tested for the 21 and 24-kDa antigenic bands of G. spinigerum. Similarly, sera of 11 gnathostomiasis patients were tested for the 29-kDa diagnostic band for A. cantonensis. Only one patient in the angiostrongyliasis group had a positive result for the 21 and 24-kDa antigenic bands of G. spinigerum, while no gnathostomiasis patients showed a positive result for the 29-kDa antigenic band of A. cantonensis. The specificity of the 21 and 24-kDa antigenic bands for gnathostomiasis and the 29-kDa antigenic band for A. cantonensis was 95.5% and 100%, respectively. The antigenic bands for the diagnosis of gnathostomiasis and angiostrongyliasis in EOM were highly specific.     

Cerebrospinal fluid eotaxin and eotaxin-2 levels in human eosinophilic meningitis associated with angiostrongyliasis

Eosinophilic meningitis associated angiostrongyliasis (EOMA) is a harmful disease of the brain and spinal cord caused by a parasitic helminth, Angiostrongylus cantonensis, presenting with severe headaches and cerebrospinal fluid (CSF) eosinophilia. However, the immunologic pathophysiology especially in relation to the eosinophilic inflammation is still unknown. We measured the CSF concentrations of eotaxin and eotaxin-2 of 30 patients and 10 controls. The CSF eotaxin and eotaxin-2 levels of the EOMA patients were significantly higher than those of the controls (p<0.001). The positive detection values were 83.3% (25/30) and 93.3% (28/30) for eotaxin and eotaxin-2, respectively. CSF eotaxin-2 levels also correlated with CSF eosinophilia (p=0.002). These results might indicate that the recruitment of eosinophils to the brain and spinal cord in EOMA patients could be related to elevated eotaxin-2 levels.     

Superior divisional oculomotor nerve palsy caused by midbrain neurocysticercosis

Superior divisional oculomotor nerve palsy caused by intrinsic brainstem disease occurs rarely. We herein report, to our knowledge, the first case of midbrain neurocysticercosis presenting as isolated superior divisional paresis of the oculomotor nerve. A 25-year-old woman presented with acute onset of headache and ptosis-upgaze palsy of the right eye. Results of the CT scan and MRI of the brain were compatible with neurocysticercosis at the left midbrain. She was dramatically responded to albendazole treatment. The diagnosis was confirmed by positive enzyme-linked immunosorbent assay (ELISA) test for cysticercus in her serum.